Can we win the battle against cancer?

Today (4th February) is World Cancer Day. It is an opportunity to unite the world’s population in the fight against cancer by raising awareness and education about the disease; and pressing governments and individuals across the world to take action to save millions of preventable deaths each year. Currently 8.2 million people die from cancer worldwide every year out of which 4 million die prematurely (30-69 years).
As per data of the Indian Council of Medical Research, the cases of various types of cancer are on the rise in India. The estimated incidence of cancer in 2014 in the country was 1117269 (up from 1028503 in 2011), out of which the highest number (186638) was from Uttar Pradesh.This increase in the number of cases may be attributed to the use of tobacco and tobacco products, unhealthy life styles, unhealthy diet, ageing population, etc. Out of all types of cancers, lung cancer is the most common cancer. Globally more women die of lung cancer than breast, ovarian, and uterine cancers combined. The disease remains as the most common cancer in men too (1.2 million). Worldwide 1,800,000 people develop lung cancer and 75% of them (1,600,000) die of it every year. For India these figures are 70,275 and 63,759 respectively.

Tobacco use accounts for 30% of all cancers and 87% of lung cancers. It causes around 20% of global cancer deaths and 70% of lung cancer deaths. There is a 10 fold increased risk of lung cancer in smokers and 20 times more risk in heavy smokers. Even nonsmokers are more likely to develop lung cancer if they regularly encounter second-hand smoke at home or at work. During a webinar organised recently by CNS, Dr Patricia Rivera, from the American College of Chest Physicians and Forum of International Respiratory Societies, drew attention to the fact that recognising the signs of lung cancer is key to early detection and life saving treatment. She also said that, “While smoking is a high risk factor for lung cancer, there are other lesser known, but equally important, risk factors. Radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer, and anyone who has worked with these substances is at increased risk of it. Its risk also increases with age.”

Very often symptoms of lung cancer mimic those of pulmonary TB. Dr Surya Kant, Head of Respiratory Medicine Department, King George's Medical University, listed some such symptoms — a worsening cough that lasts for long; expectoration; fever; shortness of breath, chest pain, and weight loss. He also mentioned some clinical features that are different too—“It is usually the young who get TB and middle aged/elderly who get lung cancer. Also smoking history is usually present in lung cancer but could be present or absent in TB; there is significant weight loss in both but sudden in lung cancer and slow in TB; breathlessness in TB is marked and specific but vague and dull in lung cancer.” With a history of active tobacco smoking present in 87% of male and 85% of female lung cancer patients, Dr Surya Kant reiterated that cigarette/bidi smoking is the single most important risk factor for lung cancer.

Prof Elif Dagli, noted tobacco control expert from the International Union Against Tuberculosis and Lung Disease (The Union) warns about the killing effects of a new tobacco fad—sheesha/water pipe/hookah smoking—that is spreading its tentacles, especially among the youth. It is a common misconception that this form of smoking is a safe alternative to cigarettes. Even after passing through water, main stream water pipe smoke contains charcoal combustion products, metals, carcinogens, carbon monoxide, volatile aldehydes, a very large number of ultra fine particles and other toxicants.

Water pipe tobacco is mixed with sweeteners and aromatic flavours to make it more appealing to youth. A single puff from a water pipe is equal to the smoke inhaled from an entire cigarette. A report issued by the World Health Organization has revealed that smoking hookah for an hour can be just as detrimental to our health as smoking 100 cigarettes. Cigarette smokers take 8-12, 40-75ml puffs over 5-7 minutes an inhale 0.5 litres of smoke. Water pipe session typically lasts 20-80minutes, smokers take 50-200 puffs, 0.15 to 1 litre each. Second hand smoke from water pipes contains tobacco and fuel chemicals. A study investigated indoor air quality in hookah bars in New York. The results demonstrated that hookah bars have elevated concentrations of indoor air pollutants that seem to cause adverse health effects in the employees. Health risks of water pipe smoking include lung cancer, low birth weight and Hepatitis C. Moreover sharing water pipes may transmit infections.

Dr Tara Singh Bam, Regional Advisor (Tobacco Control) at The Union, avers that the tobacco epidemic cannot be resolved in hospitals and clinics, but in the corridors of power. Political will is crucial to not only set goals and targets but also achieve them. All of us need to do more of the same based on proven evidence based strategies. Preventing initiation in adolescents could by far be the most effective tobacco use prevention strategy. At individual level the least each on of us can do is to say NO to tobacco; make healthy life style choices; challenge perceptions; shape policy change— all with the aim to prevent cancer.